Sign-out: 81M, SVT now stable.
Suddenly, HR 160 and MAP drops 85 to 70
What’s your schema for this situation?
What key data informs your treatment?
How do you convey your thinking to the room?
You share your assessment and plan to administer IV metoprolol with the team, then…
3 individuals (DOCTOR badges) you don’t know enter the room and don’t introduce themselves.
You discuss the situation with the family outside the room - many questions.
RN asks clarification: what metoprolol dose?
While with family, RN shouts “patient’s not responding”. New EKG:
DOCTORS are primary CV team, who are unaware it’s a rapid.
Primary team had also told the RN to give Metop, leading to multiple doses.
Patient required transcutaneous pacing - who decides?
What went wrong?
“I’m __, resident on the code team. Is anyone running this rapid?”
“Ok, I’m running this rapid”, or
“Can I take Over”, or
“OK, how can I help?”
Try:
Think out loud: “Wide QRS, but rhythm is irregular”
Summarize: “MAP is OK, I think this is AFib, so…”
Encourage: “Good thought, yes…”
Why?
Consider (actual) team dynamics: e.g. Resident-ICU RN, primary team
The team has a lot of context-specific experience
Primary team identified; confirmed they want you to run response
Standing at the head of the bed, delegating all other tasks.
You verbalize your rhythm interpretation schema.
Ideas from the entire team